<html><head><meta http-equiv="Content-Type" content="text/html; charset=ISO-8859-1">
    <title>WHV Application Information</title>
    <style>
    body {
      margin: 0px;
      padding: 0px;
      background: #4682b4;
    }

    div:first-child {
      margin-top: 0px;
    }

    div {
      cursor: pointer;
      text-align: center;
      padding: 1px 3px;
      font-family: sans-serif;
      font-size: 0.8em;
      width: 1024px;
      margin-top: 1px;
      background: #4682b4;
    }
    #saved {
      border: 1px solid white;
    }
    </style>
    
  </head>
  <body>
  		<div class="loginBox">
			<table id="Footer_newFooter_loginControl_securityPanel" defaultbutton="loginImageButton" cellpadding="0" cellspacing="0" border="0" width="100%"><tbody><tr><td>
			
				<div style="PADDING-BOTTOM:10px; PADDING-LEFT:5px; PADDING-RIGHT:5px; PADDING-TOP:0px">
					<span class="OStitle">Online services login</span><br>
					<div>Username</div><input name="Footer:newFooter:loginControl:userNameTextBox" type="text" id="Footer_newFooter_loginControl_userNameTextBox" class="userName" autocomplete="off" style="Z-INDEX: 0">
					<div id="password">
						<div>Password</div><input name="Footer:newFooter:loginControl:passwordTextBox" type="password" id="Footer_newFooter_loginControl_passwordTextBox" class="passWord" autocomplete="off" style="Z-INDEX: 0">
					</div>
				</div>
			
		</td></tr></tbody></table>			
		</div>
    <div id="red"><table width="100%">
	<tbody><tr>
		<td width="35%">Family name <br>(as in passport)</td>
		<td width="35%" nowrap=""><input name="ctl00$ContentPlaceHolder1$personDetails$familyNameTextBox" type="text" maxlength="50" id="ctl00_ContentPlaceHolder1_personDetails_familyNameTextBox" size="30">
			<span id="ctl00_ContentPlaceHolder1_personDetails_familyNameMandatoryLabel" title="Field is mandatory" class="ErrorMessageSmall">&nbsp;*</span></td>
		<td></td>
	</tr>
	<tr>
		<td>Given name 1 <br>(as in passport)</td>
		<td nowrap=""><input name="ctl00$ContentPlaceHolder1$personDetails$givenName1Textbox" type="text" maxlength="30" id="ctl00_ContentPlaceHolder1_personDetails_givenName1Textbox" size="30">
			<span id="ctl00_ContentPlaceHolder1_personDetails_givenName1MandatoryLabel" title="Field is mandatory" class="ErrorMessageSmall">&nbsp;*</span></td>
		<td></td>
	</tr>
	<tr>
		<td>Gender</td>
		<td nowrap="">
			<select name="ctl00$ContentPlaceHolder1$personDetails$genderDropDownList" id="ctl00_ContentPlaceHolder1_personDetails_genderDropDownList">
			<option selected="selected" value="">Select an option</option>
			<option value="M">Male</option>
			<option value="F">Female</option>

		</select>
			<span id="ctl00_ContentPlaceHolder1_personDetails_genderMandatoryLabel" title="Field is mandatory" class="ErrorMessageSmall">&nbsp;*</span></td>
		<td></td>
	</tr>
	<tr>
		<td class="FieldLabel" valign="top">Date of birth</td>
		<td valign="top" nowrap=""><select name="ctl00_ContentPlaceHolder1_personDetails_dateOfBithDatePicker_Day" id="ctl00_ContentPlaceHolder1_personDetails_dateOfBithDatePicker_Day" onchange="javascript: initVars(true, document.forms[0].ctl00_ContentPlaceHolder1_personDetails_dateOfBithDatePicker_MinDate, document.forms[0].ctl00_ContentPlaceHolder1_personDetails_dateOfBithDatePicker_MaxDate, 2, 1, 2); rebuildDays(document.forms[0].ctl00_ContentPlaceHolder1_personDetails_dateOfBithDatePicker_Day, document.forms[0].ctl00_ContentPlaceHolder1_personDetails_dateOfBithDatePicker_Month, document.forms[0].ctl00_ContentPlaceHolder1_personDetails_dateOfBithDatePicker_Year);">
	<option value="0">--</option>
	<option value="1">01</option>
	<option value="2">02</option>
	<option value="3">03</option>
	<option value="4">04</option>
	<option value="5">05</option>
	<option value="6">06</option>
	<option value="7">07</option>
	<option value="8">08</option>
	<option value="9">09</option>
	<option value="10">10</option>
	<option value="11">11</option>
	<option value="12">12</option>
	<option value="13">13</option>
	<option value="14">14</option>
	<option value="15">15</option>
	<option value="16">16</option>
	<option value="17">17</option>
	<option value="18">18</option>
	<option value="19">19</option>
	<option value="20">20</option>
	<option value="21">21</option>
	<option value="22">22</option>
	<option value="23">23</option>
	<option value="24">24</option>
	<option value="25">25</option>
	<option value="26">26</option>
	<option value="27">27</option>
	<option value="28">28</option>
	<option value="29">29</option>
	<option value="30">30</option>
	<option value="31">31</option>

</select>&nbsp;<select name="ctl00_ContentPlaceHolder1_personDetails_dateOfBithDatePicker_Month" id="ctl00_ContentPlaceHolder1_personDetails_dateOfBithDatePicker_Month" onchange="javascript: initVars(true, document.forms[0].ctl00_ContentPlaceHolder1_personDetails_dateOfBithDatePicker_MinDate, document.forms[0].ctl00_ContentPlaceHolder1_personDetails_dateOfBithDatePicker_MaxDate, 2, 1, 2); rebuildMonths(document.forms[0].ctl00_ContentPlaceHolder1_personDetails_dateOfBithDatePicker_Day, document.forms[0].ctl00_ContentPlaceHolder1_personDetails_dateOfBithDatePicker_Month, document.forms[0].ctl00_ContentPlaceHolder1_personDetails_dateOfBithDatePicker_Year);">
	<option value="0">---</option>
	<option value="1">Jan</option>
	<option value="2">Feb</option>
	<option value="3">Mar</option>
	<option value="4">Apr</option>
	<option value="5">May</option>
	<option value="6">Jun</option>
	<option value="7">Jul</option>
	<option value="8">Aug</option>
	<option value="9">Sep</option>
	<option value="10">Oct</option>
	<option value="11">Nov</option>
	<option value="12">Dec</option>

</select>&nbsp;<select name="ctl00_ContentPlaceHolder1_personDetails_dateOfBithDatePicker_Year" id="ctl00_ContentPlaceHolder1_personDetails_dateOfBithDatePicker_Year" onchange="javascript: initVars(true, document.forms[0].ctl00_ContentPlaceHolder1_personDetails_dateOfBithDatePicker_MinDate, document.forms[0].ctl00_ContentPlaceHolder1_personDetails_dateOfBithDatePicker_MaxDate, 2, 1, 2); rebuildYears(document.forms[0].ctl00_ContentPlaceHolder1_personDetails_dateOfBithDatePicker_Day, document.forms[0].ctl00_ContentPlaceHolder1_personDetails_dateOfBithDatePicker_Month, document.forms[0].ctl00_ContentPlaceHolder1_personDetails_dateOfBithDatePicker_Year);">
	<option value="0">----</option>
	<option value="1982">1982</option>
	<option value="1983">1983</option>
	<option value="1984">1984</option>
	<option value="1985">1985</option>
	<option value="1986">1986</option>
	<option value="1987">1987</option>
	<option value="1988">1988</option>
	<option value="1989">1989</option>
	<option value="1990">1990</option>
	<option value="1991">1991</option>
	<option value="1992">1992</option>
	<option value="1993">1993</option>
	<option value="1994">1994</option>
	<option value="1995">1995</option>
	<option value="1996">1996</option>
	<option value="1997">1997</option>
	<option value="1998">1998</option>
	<option value="1999">1999</option>
	<option value="2000">2000</option>
	<option value="2001">2001</option>
	<option value="2002">2002</option>
	<option value="2003">2003</option>
	<option value="2004">2004</option>
	<option value="2005">2005</option>
	<option value="2006">2006</option>
	<option value="2007">2007</option>
	<option value="2008">2008</option>
	<option value="2009">2009</option>
	<option value="2010">2010</option>
	<option value="2011">2011</option>
	<option value="2012">2012</option>
	<option value="2013">2013</option>

</select>&nbsp;<input name="ctl00$ContentPlaceHolder1$personDetails$dateOfBithDatePicker" type="hidden" id="ctl00_ContentPlaceHolder1_personDetails_dateOfBithDatePicker"><input name="ctl00_ContentPlaceHolder1_personDetails_dateOfBithDatePicker_MaxDate" type="hidden" id="ctl00_ContentPlaceHolder1_personDetails_dateOfBithDatePicker_MaxDate" value="04 Oct 2013"><input name="ctl00_ContentPlaceHolder1_personDetails_dateOfBithDatePicker_MinDate" type="hidden" id="ctl00_ContentPlaceHolder1_personDetails_dateOfBithDatePicker_MinDate" value="04 Oct 1982"><input name="ctl00_ContentPlaceHolder1_personDetails_dateOfBithDatePicker_ControlState" type="hidden" id="ctl00_ContentPlaceHolder1_personDetails_dateOfBithDatePicker_ControlState" value="/wEXBQUMU2VsZWN0ZWREYXRlBgAAAAAAAAAABQxQcmV2aW91c0RhdGUGAAAAAAAAAAAFB01heERhdGUGALis1j6O0IgFEFNlbGVjdGVkRGF0ZVRleHQFBTAtMC0wBQdNaW5EYXRlBgB4TeOXzK2I">
			<span id="ctl00_ContentPlaceHolder1_personDetails_dateOfBithMandatoryLabel" title="Field is mandatory" class="ErrorMessageSmall">&nbsp;*</span></td>
		<td></td>
	</tr>
	<tr>
		<td>Country of birth</td>
		<td nowrap="">
			<select name="ctl00$ContentPlaceHolder1$personDetails$CountryDropDownList" id="ctl00_ContentPlaceHolder1_personDetails_CountryDropDownList">
			<option selected="selected" value="">Select an option</option>
			<option value="4">Afghanistan</option>
			<option value="5">Albania</option>
			<option value="6">Algeria</option>
			<option value="7">American Samoa</option>
			<option value="8">Andorra</option>
			<option value="9">Angola</option>
			<option value="10">Anguilla</option>
			<option value="11">Antarctica</option>
			<option value="12">Antigua &amp; Barbuda</option>
			<option value="13">Argentina</option>
			<option value="14">Armenia</option>
			<option value="15">Aruba</option>
			<option value="16">Australia</option>
			<option value="17">Austria</option>
			<option value="18">Azerbaijan</option>
			<option value="19">Bahamas</option>
			<option value="20">Bahrain</option>
			<option value="21">Bangladesh</option>
			<option value="22">Barbados</option>
			<option value="23">Belarus</option>
			<option value="24">Belgium</option>
			<option value="25">Belize</option>
			<option value="26">Benin</option>
			<option value="27">Bermuda</option>
			<option value="28">Bhutan</option>
			<option value="29">Bolivia</option>
			<option value="30">Bosnia &amp; Herzegovina</option>
			<option value="31">Botswana</option>
			<option value="32">Brazil</option>
			<option value="33">British Indian Ocean Territory</option>
			<option value="34">Brunei Darussalam</option>
			<option value="35">Bulgaria</option>
			<option value="36">Burkina Faso</option>
			<option value="37">Burundi</option>
			<option value="38">Cambodia</option>
			<option value="39">Cameroon</option>
			<option value="40">Canada</option>
			<option value="41">Cape Verde</option>
			<option value="42">Cayman Islands</option>
			<option value="43">Central African Republic</option>
			<option value="44">Chad</option>
			<option value="45">Chile</option>
			<option value="46">China</option>
			<option value="47">Christmas Island</option>
			<option value="48">Cocos (Keeling) Island</option>
			<option value="49">Colombia</option>
			<option value="50">Comoros</option>
			<option value="51">Congo</option>
			<option value="52">Cook Islands</option>
			<option value="53">Costa Rica</option>
			<option value="54">Croatia</option>
			<option value="55">Cuba</option>
			<option value="56">Cyprus</option>
			<option value="57">Czech Republic</option>
			<option value="58">Democratic Republic of Congo</option>
			<option value="59">Denmark</option>
			<option value="60">Djibouti</option>
			<option value="61">Dominica</option>
			<option value="62">Dominican Republic</option>
			<option value="63">East Timor</option>
			<option value="64">Ecuador</option>
			<option value="65">Egypt</option>
			<option value="66">El Salvador</option>
			<option value="67">Equitorial Guinea</option>
			<option value="68">Eritrea</option>
			<option value="69">Estonia</option>
			<option value="70">Ethiopia</option>
			<option value="71">Faeroe Islands</option>
			<option value="72">Falkland Islands</option>
			<option value="73">Federated States of Micronesia</option>
			<option value="74">Fiji</option>
			<option value="75">Finland</option>
			<option value="76">France</option>
			<option value="77">French Guiana</option>
			<option value="78">French Polynesia</option>
			<option value="79">Gabon</option>
			<option value="80">Gambia</option>
			<option value="81">Georgia</option>
			<option value="82">Germany</option>
			<option value="83">Ghana</option>
			<option value="84">Gibraltar</option>
			<option value="85">Great Britain</option>
			<option value="86">Greece</option>
			<option value="87">Greenland</option>
			<option value="88">Grenada</option>
			<option value="89">Guadeloupe</option>
			<option value="90">Guam</option>
			<option value="91">Guatemala</option>
			<option value="92">Guinea</option>
			<option value="93">Guinea - Bissau</option>
			<option value="94">Guyana</option>
			<option value="95">Haiti</option>
			<option value="96">Honduras</option>
			<option value="97">Hong Kong</option>
			<option value="98">Hungary</option>
			<option value="99">Iceland</option>
			<option value="100">India</option>
			<option value="101">Indonesia</option>
			<option value="102">Iran</option>
			<option value="103">Iraq</option>
			<option value="104">Ireland</option>
			<option value="105">Israel</option>
			<option value="106">Italy</option>
			<option value="107">Ivory Coast</option>
			<option value="108">Jamaica</option>
			<option value="109">Japan</option>
			<option value="110">Jordan</option>
			<option value="111">Kazakhstan</option>
			<option value="112">Kenya</option>
			<option value="113">Kiribati</option>
			<option value="114">Kosovo - UN Mission in</option>
			<option value="250">Kosovo - Republic of</option>
			<option value="115">Kuwait</option>
			<option value="116">Kyrgyzstan</option>
			<option value="117">Laos</option>
			<option value="118">Latvia</option>
			<option value="119">Lebanon</option>
			<option value="120">Lesotho</option>
			<option value="121">Liberia</option>
			<option value="122">Libya</option>
			<option value="123">Liechtenstein</option>
			<option value="124">Lithuania</option>
			<option value="125">Luxembourg</option>
			<option value="126">Macau</option>
			<option value="127">Macedonia</option>
			<option value="128">Madagascar</option>
			<option value="129">Malawi</option>
			<option value="130">Malaysia</option>
			<option value="131">Maldives</option>
			<option value="132">Mali</option>
			<option value="133">Malta</option>
			<option value="134">Marshall Islands</option>
			<option value="135">Martinique</option>
			<option value="136">Mauritania</option>
			<option value="137">Mauritius</option>
			<option value="138">Mayotte</option>
			<option value="139">Mexico</option>
			<option value="140">Moldova</option>
			<option value="141">Monaco</option>
			<option value="142">Mongolia</option>
			<option value="248">Montenegro</option>
			<option value="143">Montserrat</option>
			<option value="144">Morocco</option>
			<option value="145">Mozambique</option>
			<option value="146">Myanmar</option>
			<option value="147">Namibia</option>
			<option value="148">Nauru</option>
			<option value="149">Nepal</option>
			<option value="150">Netherlands</option>
			<option value="151">Netherlands Antilles</option>
			<option value="152">New Caledonia</option>
			<option value="153">New Zealand</option>
			<option value="154">Nicaragua</option>
			<option value="155">Niger</option>
			<option value="156">Nigeria</option>
			<option value="157">Niue</option>
			<option value="158">Norfolk Island</option>
			<option value="159">North Korea</option>
			<option value="160">Northern Mariana Islands</option>
			<option value="161">Norway</option>
			<option value="162">Oman</option>
			<option value="163">Pacific Island Trust Territory</option>
			<option value="164">Pakistan</option>
			<option value="165">Palau</option>
			<option value="166">Palestine</option>
			<option value="167">Panama</option>
			<option value="168">Papua New Guinea</option>
			<option value="169">Paraguay</option>
			<option value="170">Peru</option>
			<option value="171">Philippines</option>
			<option value="172">Pitcairn Islands</option>
			<option value="173">Poland</option>
			<option value="174">Portugal</option>
			<option value="175">Puerto Rico</option>
			<option value="176">Qatar</option>
			<option value="177">Reunion</option>
			<option value="178">Romania</option>
			<option value="179">Russia</option>
			<option value="180">Rwanda</option>
			<option value="181">Samoa</option>
			<option value="182">San Marino</option>
			<option value="183">Sao Tome &amp; Principe</option>
			<option value="184">Saudi Arabia</option>
			<option value="185">Senegal</option>
			<option value="247">Serbia</option>
			<option value="249">Serbia &amp; Montenegro</option>
			<option value="186">Seychelles</option>
			<option value="187">Sierra Leone</option>
			<option value="188">Singapore</option>
			<option value="189">Slovakia</option>
			<option value="190">Slovenia</option>
			<option value="191">Solomon Islands</option>
			<option value="192">Somalia</option>
			<option value="193">South Africa</option>
			<option value="194">South Korea</option>
			<option value="195">South Pacific commission</option>
			<option value="251">South Sudan</option>
			<option value="196">Soviet Union</option>
			<option value="197">Spain</option>
			<option value="198">Sri Lanka</option>
			<option value="199">St Helena</option>
			<option value="200">St Kitts - Nevis</option>
			<option value="201">St Lucia</option>
			<option value="202">St Pierre &amp; Miquelon</option>
			<option value="203">St Vincent and the Grenadines</option>
			<option value="204">Sth Georgia &amp; Sandwich Islands</option>
			<option value="205">Sudan</option>
			<option value="206">Suriname</option>
			<option value="207">Swaziland</option>
			<option value="208">Sweden</option>
			<option value="209">Switzerland</option>
			<option value="210">Syria</option>
			<option value="211">Taiwan</option>
			<option value="212">Tajikistan</option>
			<option value="213">Tanzania</option>
			<option value="214">Thailand</option>
			<option value="215">Timor Leste</option>
			<option value="216">Togo</option>
			<option value="217">Tokelau</option>
			<option value="218">Tonga</option>
			<option value="219">Trinidad and Tobago</option>
			<option value="220">Tunisia</option>
			<option value="221">Turkemenistan</option>
			<option value="222">Turkey</option>
			<option value="223">Turks and Caicos Islands</option>
			<option value="224">Tuvalu</option>
			<option value="225">Uganda</option>
			<option value="226">Ukraine</option>
			<option value="227">United Arab Emirates</option>
			<option value="228">United Nations</option>
			<option value="229">United States of America</option>
			<option value="230">Uruguay</option>
			<option value="231">US Outlying Islands</option>
			<option value="232">US Pacific Islands</option>
			<option value="233">Uzbekistan</option>
			<option value="234">Vanuatu</option>
			<option value="235">Vatican City</option>
			<option value="236">Venezuela</option>
			<option value="237">Vietnam</option>
			<option value="238">Virgin Islands, British</option>
			<option value="239">Virgin Islands, USA</option>
			<option value="240">Wallis and Futuna</option>
			<option value="241">Western Sahara</option>
			<option value="242">Yemen</option>
			<option value="243">Yugoslavia</option>
			<option value="244">Zambia</option>
			<option value="245">Zimbabwe</option>

		</select>
			<span id="ctl00_ContentPlaceHolder1_personDetails_countryMandatoryLabel" title="Field is mandatory" class="ErrorMessageSmall">&nbsp;*</span></td>
		<td></td>
	</tr>
</tbody></table>
</div>
    <div id="blue"><table width="100%">
	<tbody>
	<tr>
		<td>Street Name</td>
		<td nowrap=""><input name="ctl00$ContentPlaceHolder1$addressContactDetails$address$address1TextBox" type="text" maxlength="100" size="55" id="ctl00_ContentPlaceHolder1_addressContactDetails_address_address1TextBox"><span id="ctl00_ContentPlaceHolder1_addressContactDetails_address_address1MandatoryLabel" title="Field is mandatory" class="ErrorMessageSmall">&nbsp;*</span></td>
		<td></td>
	</tr>
	<tr>
		<td>City</td>
		<td nowrap=""><input name="ctl00$ContentPlaceHolder1$addressContactDetails$address$cityTextBox" type="text" maxlength="100" id="ctl00_ContentPlaceHolder1_addressContactDetails_address_cityTextBox" size="30"><span id="ctl00_ContentPlaceHolder1_addressContactDetails_address_cityMandatoryLabel" title="Field is mandatory" class="ErrorMessageSmall">&nbsp;*</span></td>
		<td></td>
	</tr>
	<tr>
		<td>Country</td>
		<td nowrap="">
			<select name="ctl00$ContentPlaceHolder1$addressContactDetails$address$countryDropDownList" id="ctl00_ContentPlaceHolder1_addressContactDetails_address_countryDropDownList">
			<option selected="selected" value="">Select an option</option>
			<option value="4">Afghanistan</option>
			<option value="5">Albania</option>
			<option value="6">Algeria</option>
			<option value="7">American Samoa</option>
			<option value="8">Andorra</option>
			<option value="9">Angola</option>
			<option value="10">Anguilla</option>
			<option value="11">Antarctica</option>
			<option value="12">Antigua &amp; Barbuda</option>
			<option value="13">Argentina</option>
			<option value="14">Armenia</option>
			<option value="15">Aruba</option>
			<option value="16">Australia</option>
			<option value="17">Austria</option>
			<option value="18">Azerbaijan</option>
			<option value="19">Bahamas</option>
			<option value="20">Bahrain</option>
			<option value="21">Bangladesh</option>
			<option value="22">Barbados</option>
			<option value="23">Belarus</option>
			<option value="24">Belgium</option>
			<option value="25">Belize</option>
			<option value="26">Benin</option>
			<option value="27">Bermuda</option>
			<option value="28">Bhutan</option>
			<option value="29">Bolivia</option>
			<option value="30">Bosnia &amp; Herzegovina</option>
			<option value="31">Botswana</option>
			<option value="32">Brazil</option>
			<option value="33">British Indian Ocean Territory</option>
			<option value="34">Brunei Darussalam</option>
			<option value="35">Bulgaria</option>
			<option value="36">Burkina Faso</option>
			<option value="37">Burundi</option>
			<option value="38">Cambodia</option>
			<option value="39">Cameroon</option>
			<option value="40">Canada</option>
			<option value="41">Cape Verde</option>
			<option value="42">Cayman Islands</option>
			<option value="43">Central African Republic</option>
			<option value="44">Chad</option>
			<option value="45">Chile</option>
			<option value="46">China</option>
			<option value="47">Christmas Island</option>
			<option value="48">Cocos (Keeling) Island</option>
			<option value="49">Colombia</option>
			<option value="50">Comoros</option>
			<option value="51">Congo</option>
			<option value="52">Cook Islands</option>
			<option value="53">Costa Rica</option>
			<option value="54">Croatia</option>
			<option value="55">Cuba</option>
			<option value="56">Cyprus</option>
			<option value="57">Czech Republic</option>
			<option value="58">Democratic Republic of Congo</option>
			<option value="59">Denmark</option>
			<option value="60">Djibouti</option>
			<option value="61">Dominica</option>
			<option value="62">Dominican Republic</option>
			<option value="63">East Timor</option>
			<option value="64">Ecuador</option>
			<option value="65">Egypt</option>
			<option value="66">El Salvador</option>
			<option value="67">Equitorial Guinea</option>
			<option value="68">Eritrea</option>
			<option value="69">Estonia</option>
			<option value="70">Ethiopia</option>
			<option value="71">Faeroe Islands</option>
			<option value="72">Falkland Islands</option>
			<option value="73">Federated States of Micronesia</option>
			<option value="74">Fiji</option>
			<option value="75">Finland</option>
			<option value="76">France</option>
			<option value="77">French Guiana</option>
			<option value="78">French Polynesia</option>
			<option value="79">Gabon</option>
			<option value="80">Gambia</option>
			<option value="81">Georgia</option>
			<option value="82">Germany</option>
			<option value="83">Ghana</option>
			<option value="84">Gibraltar</option>
			<option value="85">Great Britain</option>
			<option value="86">Greece</option>
			<option value="87">Greenland</option>
			<option value="88">Grenada</option>
			<option value="89">Guadeloupe</option>
			<option value="90">Guam</option>
			<option value="91">Guatemala</option>
			<option value="92">Guinea</option>
			<option value="93">Guinea - Bissau</option>
			<option value="94">Guyana</option>
			<option value="95">Haiti</option>
			<option value="96">Honduras</option>
			<option value="97">Hong Kong</option>
			<option value="98">Hungary</option>
			<option value="99">Iceland</option>
			<option value="100">India</option>
			<option value="101">Indonesia</option>
			<option value="102">Iran</option>
			<option value="103">Iraq</option>
			<option value="104">Ireland</option>
			<option value="105">Israel</option>
			<option value="106">Italy</option>
			<option value="107">Ivory Coast</option>
			<option value="108">Jamaica</option>
			<option value="109">Japan</option>
			<option value="110">Jordan</option>
			<option value="111">Kazakhstan</option>
			<option value="112">Kenya</option>
			<option value="113">Kiribati</option>
			<option value="114">Kosovo - UN Mission in</option>
			<option value="250">Kosovo - Republic of</option>
			<option value="115">Kuwait</option>
			<option value="116">Kyrgyzstan</option>
			<option value="117">Laos</option>
			<option value="118">Latvia</option>
			<option value="119">Lebanon</option>
			<option value="120">Lesotho</option>
			<option value="121">Liberia</option>
			<option value="122">Libya</option>
			<option value="123">Liechtenstein</option>
			<option value="124">Lithuania</option>
			<option value="125">Luxembourg</option>
			<option value="126">Macau</option>
			<option value="127">Macedonia</option>
			<option value="128">Madagascar</option>
			<option value="129">Malawi</option>
			<option value="130">Malaysia</option>
			<option value="131">Maldives</option>
			<option value="132">Mali</option>
			<option value="133">Malta</option>
			<option value="134">Marshall Islands</option>
			<option value="135">Martinique</option>
			<option value="136">Mauritania</option>
			<option value="137">Mauritius</option>
			<option value="138">Mayotte</option>
			<option value="139">Mexico</option>
			<option value="140">Moldova</option>
			<option value="141">Monaco</option>
			<option value="142">Mongolia</option>
			<option value="248">Montenegro</option>
			<option value="143">Montserrat</option>
			<option value="144">Morocco</option>
			<option value="145">Mozambique</option>
			<option value="146">Myanmar</option>
			<option value="147">Namibia</option>
			<option value="148">Nauru</option>
			<option value="149">Nepal</option>
			<option value="150">Netherlands</option>
			<option value="151">Netherlands Antilles</option>
			<option value="152">New Caledonia</option>
			<option value="153">New Zealand</option>
			<option value="154">Nicaragua</option>
			<option value="155">Niger</option>
			<option value="156">Nigeria</option>
			<option value="157">Niue</option>
			<option value="158">Norfolk Island</option>
			<option value="159">North Korea</option>
			<option value="160">Northern Mariana Islands</option>
			<option value="161">Norway</option>
			<option value="162">Oman</option>
			<option value="163">Pacific Island Trust Territory</option>
			<option value="164">Pakistan</option>
			<option value="165">Palau</option>
			<option value="166">Palestine</option>
			<option value="167">Panama</option>
			<option value="168">Papua New Guinea</option>
			<option value="169">Paraguay</option>
			<option value="170">Peru</option>
			<option value="171">Philippines</option>
			<option value="172">Pitcairn Islands</option>
			<option value="173">Poland</option>
			<option value="174">Portugal</option>
			<option value="175">Puerto Rico</option>
			<option value="176">Qatar</option>
			<option value="177">Reunion</option>
			<option value="178">Romania</option>
			<option value="179">Russia</option>
			<option value="180">Rwanda</option>
			<option value="181">Samoa</option>
			<option value="182">San Marino</option>
			<option value="183">Sao Tome &amp; Principe</option>
			<option value="184">Saudi Arabia</option>
			<option value="185">Senegal</option>
			<option value="247">Serbia</option>
			<option value="249">Serbia &amp; Montenegro</option>
			<option value="186">Seychelles</option>
			<option value="187">Sierra Leone</option>
			<option value="188">Singapore</option>
			<option value="189">Slovakia</option>
			<option value="190">Slovenia</option>
			<option value="191">Solomon Islands</option>
			<option value="192">Somalia</option>
			<option value="193">South Africa</option>
			<option value="194">South Korea</option>
			<option value="195">South Pacific commission</option>
			<option value="251">South Sudan</option>
			<option value="196">Soviet Union</option>
			<option value="197">Spain</option>
			<option value="198">Sri Lanka</option>
			<option value="199">St Helena</option>
			<option value="200">St Kitts - Nevis</option>
			<option value="201">St Lucia</option>
			<option value="202">St Pierre &amp; Miquelon</option>
			<option value="203">St Vincent and the Grenadines</option>
			<option value="204">Sth Georgia &amp; Sandwich Islands</option>
			<option value="205">Sudan</option>
			<option value="206">Suriname</option>
			<option value="207">Swaziland</option>
			<option value="208">Sweden</option>
			<option value="209">Switzerland</option>
			<option value="210">Syria</option>
			<option value="211">Taiwan</option>
			<option value="212">Tajikistan</option>
			<option value="213">Tanzania</option>
			<option value="214">Thailand</option>
			<option value="215">Timor Leste</option>
			<option value="216">Togo</option>
			<option value="217">Tokelau</option>
			<option value="218">Tonga</option>
			<option value="219">Trinidad and Tobago</option>
			<option value="220">Tunisia</option>
			<option value="221">Turkemenistan</option>
			<option value="222">Turkey</option>
			<option value="223">Turks and Caicos Islands</option>
			<option value="224">Tuvalu</option>
			<option value="225">Uganda</option>
			<option value="226">Ukraine</option>
			<option value="227">United Arab Emirates</option>
			<option value="228">United Nations</option>
			<option value="229">United States of America</option>
			<option value="230">Uruguay</option>
			<option value="231">US Outlying Islands</option>
			<option value="232">US Pacific Islands</option>
			<option value="233">Uzbekistan</option>
			<option value="234">Vanuatu</option>
			<option value="235">Vatican City</option>
			<option value="236">Venezuela</option>
			<option value="237">Vietnam</option>
			<option value="238">Virgin Islands, British</option>
			<option value="239">Virgin Islands, USA</option>
			<option value="240">Wallis and Futuna</option>
			<option value="241">Western Sahara</option>
			<option value="242">Yemen</option>
			<option value="243">Yugoslavia</option>
			<option value="244">Zambia</option>
			<option value="245">Zimbabwe</option>

		</select>
			<span id="ctl00_ContentPlaceHolder1_addressContactDetails_address_countryMandatoryLabel" title="Field is mandatory" class="ErrorMessageSmall">&nbsp;*</span></td>
		<td></td>
	</tr>
</tbody></table>
</div>
    <div id="green">
    	<table class="form" id="Table1" width="100%">
	<tbody>
	<tr>
		<td>Email address
			<br>
			(this address will be used to contact you about this application).</td>
		<td nowrap=""><input name="ctl00$ContentPlaceHolder1$addressContactDetails$contactDetails$emailAddressTextBox" type="text" maxlength="100" id="ctl00_ContentPlaceHolder1_addressContactDetails_contactDetails_emailAddressTextBox" size="30">
			<span id="ctl00_ContentPlaceHolder1_addressContactDetails_contactDetails_emailAddressMandatoryLabel" title="Field is mandatory" class="ErrorMessageSmall">&nbsp;*</span></td>
		<td></td>
	</tr>
</tbody></table>
</div>
    <div id="option"><table width="100%">
	<tbody><tr>
		<td width="35%">Are you represented by an <a href="http://glossary.immigration.govt.nz/immigrationadviser" id="ctl00_ContentPlaceHolder1_hasAgent_immigrationAdviserHelpAnchor" target="_blank" onclick="window.open('http://glossary.immigration.govt.nz/immigrationadviser','newpopup','toolbar=no,location=no,status=yes,menubar=no,scrollbars=yes,resizable=yes,width=600,height=434'); return false" title="Link opens in a new window">immigration adviser</a>?</td>
		<td width="35%" nowrap="">
			<select name="ctl00$ContentPlaceHolder1$hasAgent$representedByAgentDropdownlist" id="ctl00_ContentPlaceHolder1_hasAgent_representedByAgentDropdownlist">
			<option selected="selected" value="">Select an option</option>
			<option value="No">No</option>
			<option value="Yes">Yes</option>

		</select>
			<span id="ctl00_ContentPlaceHolder1_hasAgent_representedByAgentMandatoryLabel" title="Field is mandatory" class="ErrorMessageSmall">&nbsp;*</span></td>
		<td>
		</td>
	</tr>
</tbody></table></div>
    <div id="option"><table width="100%">
	<tbody><tr>
		<td width="35%">Communication method</td>
		<td width="35%" nowrap=""><select name="ctl00$ContentPlaceHolder1$communicationMethod$communicationMethodDropDownList" id="ctl00_ContentPlaceHolder1_communicationMethod_communicationMethodDropDownList">
			<option value="">Select an option</option>
			<option selected="selected" value="1">Email</option>

		</select>
			<span id="ctl00_ContentPlaceHolder1_communicationMethod_communicationMethodMandatoryLabel" title="Field is mandatory" class="ErrorMessageSmall">&nbsp;*</span></td>
		<td></td>
	</tr>
</tbody></table></div>
    <div id="option"><table width="100%">
	<tbody><tr>
		<td width="35%">Do you have a Visa or MasterCard card available for payment?</td>
		<td width="35%" nowrap="">
			<select name="ctl00$ContentPlaceHolder1$hasCreditCard$hasCreditCardDropDownlist" id="ctl00_ContentPlaceHolder1_hasCreditCard_hasCreditCardDropDownlist">
			<option selected="selected" value="">Select an option</option>
			<option value="No">No</option>
			<option value="Yes">Yes</option>

		</select>
			<span id="ctl00_ContentPlaceHolder1_hasCreditCard_hasCreditCardMandatoryLabel" title="Field is mandatory" class="ErrorMessageSmall">&nbsp;*</span></td>
		<td>
		</td>
	</tr>
</tbody></table></div>
    <div id="option"><table id="ctl00_ContentPlaceHolder1_entryTable" cellpadding="2" cellspacing="0" border="0" width="100%" class="sitetable">
	<tbody><tr>
		<td colspan="7">&nbsp;</td>
	</tr>
	<tr valign="top">
		<td width="20">&nbsp;</td>
		<td colspan="4">&nbsp;</td>
		<td width="20">&nbsp;</td>
	</tr>
	<tr valign="top">
		<td width="20">&nbsp;</td>
		<td width="20">&nbsp;</td>
		<td>
<table width="100%">
	<tbody><tr>
		<td colspan="3"><h3>Passport Details</h3></td>
	</tr>
	<tr>
		<td width="35%">Passport Number</td>
		<td width="35%" nowrap=""><input name="ctl00$ContentPlaceHolder1$identification$passportNumberTextBox" type="text" maxlength="15" id="ctl00_ContentPlaceHolder1_identification_passportNumberTextBox" size="15">
			<span id="ctl00_ContentPlaceHolder1_identification_passportNumberMandatoryLabel" title="Field is mandatory" class="ErrorMessageSmall">&nbsp;*</span></td>
		<td></td>
	</tr>
	<tr>
		<td width="35%">Please re-enter Passport Number</td>
		<td width="35%" nowrap=""><input name="ctl00$ContentPlaceHolder1$identification$confirmPassportNumberTextBox" type="text" maxlength="15" id="ctl00_ContentPlaceHolder1_identification_confirmPassportNumberTextBox" size="15">
			<span id="ctl00_ContentPlaceHolder1_identification_confirmPassportNumberMandatoryLabel" title="Field is mandatory" class="ErrorMessageSmall">&nbsp;*</span></td>
		<td>&nbsp;</td>
	</tr>
	<tr>
		<td>Passport Expiry Date</td>
		<td nowrap=""><select name="ctl00_ContentPlaceHolder1_identification_passportExpiryDateDatePicker_Day" id="ctl00_ContentPlaceHolder1_identification_passportExpiryDateDatePicker_Day" onchange="javascript: initVars(true, document.forms[0].ctl00_ContentPlaceHolder1_identification_passportExpiryDateDatePicker_MinDate, document.forms[0].ctl00_ContentPlaceHolder1_identification_passportExpiryDateDatePicker_MaxDate, 2, 1, 2); rebuildDays(document.forms[0].ctl00_ContentPlaceHolder1_identification_passportExpiryDateDatePicker_Day, document.forms[0].ctl00_ContentPlaceHolder1_identification_passportExpiryDateDatePicker_Month, document.forms[0].ctl00_ContentPlaceHolder1_identification_passportExpiryDateDatePicker_Year);">
	<option value="0">--</option>
	<option value="1">01</option>
	<option value="2">02</option>
	<option value="3">03</option>
	<option value="4">04</option>
	<option value="5">05</option>
	<option value="6">06</option>
	<option value="7">07</option>
	<option value="8">08</option>
	<option value="9">09</option>
	<option value="10">10</option>
	<option value="11">11</option>
	<option value="12">12</option>
	<option value="13">13</option>
	<option value="14">14</option>
	<option value="15">15</option>
	<option value="16">16</option>
	<option value="17">17</option>
	<option value="18">18</option>
	<option value="19">19</option>
	<option value="20">20</option>
	<option value="21">21</option>
	<option value="22">22</option>
	<option value="23">23</option>
	<option value="24">24</option>
	<option value="25">25</option>
	<option value="26">26</option>
	<option value="27">27</option>
	<option value="28">28</option>
	<option value="29">29</option>
	<option value="30">30</option>
	<option value="31">31</option>

</select>&nbsp;<select name="ctl00_ContentPlaceHolder1_identification_passportExpiryDateDatePicker_Month" id="ctl00_ContentPlaceHolder1_identification_passportExpiryDateDatePicker_Month" onchange="javascript: initVars(true, document.forms[0].ctl00_ContentPlaceHolder1_identification_passportExpiryDateDatePicker_MinDate, document.forms[0].ctl00_ContentPlaceHolder1_identification_passportExpiryDateDatePicker_MaxDate, 2, 1, 2); rebuildMonths(document.forms[0].ctl00_ContentPlaceHolder1_identification_passportExpiryDateDatePicker_Day, document.forms[0].ctl00_ContentPlaceHolder1_identification_passportExpiryDateDatePicker_Month, document.forms[0].ctl00_ContentPlaceHolder1_identification_passportExpiryDateDatePicker_Year);">
	<option value="0">---</option>
	<option value="1">Jan</option>
	<option value="2">Feb</option>
	<option value="3">Mar</option>
	<option value="4">Apr</option>
	<option value="5">May</option>
	<option value="6">Jun</option>
	<option value="7">Jul</option>
	<option value="8">Aug</option>
	<option value="9">Sep</option>
	<option value="10">Oct</option>
	<option value="11">Nov</option>
	<option value="12">Dec</option>

</select>&nbsp;<select name="ctl00_ContentPlaceHolder1_identification_passportExpiryDateDatePicker_Year" id="ctl00_ContentPlaceHolder1_identification_passportExpiryDateDatePicker_Year" onchange="javascript: initVars(true, document.forms[0].ctl00_ContentPlaceHolder1_identification_passportExpiryDateDatePicker_MinDate, document.forms[0].ctl00_ContentPlaceHolder1_identification_passportExpiryDateDatePicker_MaxDate, 2, 1, 2); rebuildYears(document.forms[0].ctl00_ContentPlaceHolder1_identification_passportExpiryDateDatePicker_Day, document.forms[0].ctl00_ContentPlaceHolder1_identification_passportExpiryDateDatePicker_Month, document.forms[0].ctl00_ContentPlaceHolder1_identification_passportExpiryDateDatePicker_Year);">
	<option value="0">----</option>
	<option value="2013">2013</option>
	<option value="2014">2014</option>
	<option value="2015">2015</option>
	<option value="2016">2016</option>
	<option value="2017">2017</option>
	<option value="2018">2018</option>
	<option value="2019">2019</option>
	<option value="2020">2020</option>
	<option value="2021">2021</option>
	<option value="2022">2022</option>
	<option value="2023">2023</option>
	<option value="2024">2024</option>
	<option value="2025">2025</option>
	<option value="2026">2026</option>
	<option value="2027">2027</option>
	<option value="2028">2028</option>
	<option value="2029">2029</option>
	<option value="2030">2030</option>
	<option value="2031">2031</option>
	<option value="2032">2032</option>
	<option value="2033">2033</option>
	<option value="2034">2034</option>
	<option value="2035">2035</option>
	<option value="2036">2036</option>
	<option value="2037">2037</option>
	<option value="2038">2038</option>

</select>&nbsp;<input name="ctl00$ContentPlaceHolder1$identification$passportExpiryDateDatePicker" type="hidden" id="ctl00_ContentPlaceHolder1_identification_passportExpiryDateDatePicker"><input name="ctl00_ContentPlaceHolder1_identification_passportExpiryDateDatePicker_MaxDate" type="hidden" id="ctl00_ContentPlaceHolder1_identification_passportExpiryDateDatePicker_MaxDate" value="04 Oct 2038"><input name="ctl00_ContentPlaceHolder1_identification_passportExpiryDateDatePicker_MinDate" type="hidden" id="ctl00_ContentPlaceHolder1_identification_passportExpiryDateDatePicker_MinDate" value="04 Oct 2013"><input name="ctl00_ContentPlaceHolder1_identification_passportExpiryDateDatePicker_ControlState" type="hidden" id="ctl00_ContentPlaceHolder1_identification_passportExpiryDateDatePicker_ControlState" value="/wEXBQUMU2VsZWN0ZWREYXRlBgAAAAAAAAAABQxQcmV2aW91c0RhdGUGAAAAAAAAAAAFB01heERhdGUGAPiPoGqV7IgFEFNlbGVjdGVkRGF0ZVRleHQFBTAtMC0wBQdNaW5EYXRlBgC4rNY+jtCI">
			<span id="ctl00_ContentPlaceHolder1_identification_passportExpiryDateMandatoryLabel" title="Field is mandatory" class="ErrorMessageSmall">&nbsp;*</span></td>
		<td></td>
	</tr>
	<tr>
		<td colspan="3"><h3>Second Form of Identification</h3></td>
	</tr>
	<tr>
		<td colspan="3">
			<p>
			Please enter the details of another Form of Identification you would be able to produce to prove your identity.
			</p>
		</td>
	</tr>
	<tr>
		<td>Identification Type</td>
		<td nowrap=""><select name="ctl00$ContentPlaceHolder1$identification$otherIdentificationDropdownlist" id="ctl00_ContentPlaceHolder1_identification_otherIdentificationDropdownlist">
			<option selected="selected" value="">Select an option</option>
			<option value="1">Driver License</option>
			<option value="2">Birth Certificate</option>
			<option value="3">National ID</option>

		</select>
			<span id="ctl00_ContentPlaceHolder1_identification_otherIdentificationMandatoryLabel" title="Field is mandatory" class="ErrorMessageSmall">&nbsp;*</span></td>
		<td></td>
	</tr>
	<tr>
		<td>Date Document was Issued</td>
		<td nowrap=""><select name="ctl00_ContentPlaceHolder1_identification_otherIssueDateDatePicker_Day" id="ctl00_ContentPlaceHolder1_identification_otherIssueDateDatePicker_Day" onchange="javascript: initVars(true, document.forms[0].ctl00_ContentPlaceHolder1_identification_otherIssueDateDatePicker_MinDate, document.forms[0].ctl00_ContentPlaceHolder1_identification_otherIssueDateDatePicker_MaxDate, 2, 1, 2); rebuildDays(document.forms[0].ctl00_ContentPlaceHolder1_identification_otherIssueDateDatePicker_Day, document.forms[0].ctl00_ContentPlaceHolder1_identification_otherIssueDateDatePicker_Month, document.forms[0].ctl00_ContentPlaceHolder1_identification_otherIssueDateDatePicker_Year);">
	<option value="0">--</option>
	<option value="1">01</option>
	<option value="2">02</option>
	<option value="3">03</option>
	<option value="4">04</option>
	<option value="5">05</option>
	<option value="6">06</option>
	<option value="7">07</option>
	<option value="8">08</option>
	<option value="9">09</option>
	<option value="10">10</option>
	<option value="11">11</option>
	<option value="12">12</option>
	<option value="13">13</option>
	<option value="14">14</option>
	<option value="15">15</option>
	<option value="16">16</option>
	<option value="17">17</option>
	<option value="18">18</option>
	<option value="19">19</option>
	<option value="20">20</option>
	<option value="21">21</option>
	<option value="22">22</option>
	<option value="23">23</option>
	<option value="24">24</option>
	<option value="25">25</option>
	<option value="26">26</option>
	<option value="27">27</option>
	<option value="28">28</option>
	<option value="29">29</option>
	<option value="30">30</option>
	<option value="31">31</option>

</select>&nbsp;<select name="ctl00_ContentPlaceHolder1_identification_otherIssueDateDatePicker_Month" id="ctl00_ContentPlaceHolder1_identification_otherIssueDateDatePicker_Month" onchange="javascript: initVars(true, document.forms[0].ctl00_ContentPlaceHolder1_identification_otherIssueDateDatePicker_MinDate, document.forms[0].ctl00_ContentPlaceHolder1_identification_otherIssueDateDatePicker_MaxDate, 2, 1, 2); rebuildMonths(document.forms[0].ctl00_ContentPlaceHolder1_identification_otherIssueDateDatePicker_Day, document.forms[0].ctl00_ContentPlaceHolder1_identification_otherIssueDateDatePicker_Month, document.forms[0].ctl00_ContentPlaceHolder1_identification_otherIssueDateDatePicker_Year);">
	<option value="0">---</option>
	<option value="1">Jan</option>
	<option value="2">Feb</option>
	<option value="3">Mar</option>
	<option value="4">Apr</option>
	<option value="5">May</option>
	<option value="6">Jun</option>
	<option value="7">Jul</option>
	<option value="8">Aug</option>
	<option value="9">Sep</option>
	<option value="10">Oct</option>
	<option value="11">Nov</option>
	<option value="12">Dec</option>

</select>&nbsp;<select name="ctl00_ContentPlaceHolder1_identification_otherIssueDateDatePicker_Year" id="ctl00_ContentPlaceHolder1_identification_otherIssueDateDatePicker_Year" onchange="javascript: initVars(true, document.forms[0].ctl00_ContentPlaceHolder1_identification_otherIssueDateDatePicker_MinDate, document.forms[0].ctl00_ContentPlaceHolder1_identification_otherIssueDateDatePicker_MaxDate, 2, 1, 2); rebuildYears(document.forms[0].ctl00_ContentPlaceHolder1_identification_otherIssueDateDatePicker_Day, document.forms[0].ctl00_ContentPlaceHolder1_identification_otherIssueDateDatePicker_Month, document.forms[0].ctl00_ContentPlaceHolder1_identification_otherIssueDateDatePicker_Year);">
	<option value="0">----</option>
	<option value="1982">1982</option>
	<option value="1983">1983</option>
	<option value="1984">1984</option>
	<option value="1985">1985</option>
	<option value="1986">1986</option>
	<option value="1987">1987</option>
	<option value="1988">1988</option>
	<option value="1989">1989</option>
	<option value="1990">1990</option>
	<option value="1991">1991</option>
	<option value="1992">1992</option>
	<option value="1993">1993</option>
	<option value="1994">1994</option>
	<option value="1995">1995</option>
	<option value="1996">1996</option>
	<option value="1997">1997</option>
	<option value="1998">1998</option>
	<option value="1999">1999</option>
	<option value="2000">2000</option>
	<option value="2001">2001</option>
	<option value="2002">2002</option>
	<option value="2003">2003</option>
	<option value="2004">2004</option>
	<option value="2005">2005</option>
	<option value="2006">2006</option>
	<option value="2007">2007</option>
	<option value="2008">2008</option>
	<option value="2009">2009</option>
	<option value="2010">2010</option>
	<option value="2011">2011</option>
	<option value="2012">2012</option>
	<option value="2013">2013</option>

</select>&nbsp;<input name="ctl00$ContentPlaceHolder1$identification$otherIssueDateDatePicker" type="hidden" id="ctl00_ContentPlaceHolder1_identification_otherIssueDateDatePicker"><input name="ctl00_ContentPlaceHolder1_identification_otherIssueDateDatePicker_MaxDate" type="hidden" id="ctl00_ContentPlaceHolder1_identification_otherIssueDateDatePicker_MaxDate" value="04 Oct 2013"><input name="ctl00_ContentPlaceHolder1_identification_otherIssueDateDatePicker_MinDate" type="hidden" id="ctl00_ContentPlaceHolder1_identification_otherIssueDateDatePicker_MinDate" value="04 Oct 1982"><input name="ctl00_ContentPlaceHolder1_identification_otherIssueDateDatePicker_ControlState" type="hidden" id="ctl00_ContentPlaceHolder1_identification_otherIssueDateDatePicker_ControlState" value="/wEXBQUMU2VsZWN0ZWREYXRlBgAAAAAAAAAABQxQcmV2aW91c0RhdGUGAAAAAAAAAAAFB01heERhdGUGALis1j6O0IgFEFNlbGVjdGVkRGF0ZVRleHQFBTAtMC0wBQdNaW5EYXRlBgB4TeOXzK2I">
			<span id="ctl00_ContentPlaceHolder1_identification_otherIssueDateMandatoryLabel" title="Field is mandatory" class="ErrorMessageSmall">&nbsp;*</span></td>
		<td></td>
	</tr>
</tbody></table>
<input name="ctl00$ContentPlaceHolder1$identification$passportCountryDropDownList" type="hidden" id="ctl00_ContentPlaceHolder1_identification_passportCountryDropDownList" value="214"></td>
		<td width="20">&nbsp;</td>
		<td width="20">&nbsp;</td>
	</tr>
	<tr valign="top">
		<td width="20">&nbsp;</td>
		<td colspan="4">&nbsp;</td>
		<td width="20">&nbsp;</td>
	</tr>
	<tr>
		<td colspan="7">&nbsp;</td>
	</tr>
</tbody></table></div>
    <div id="option"><table id="ctl00_ContentPlaceHolder1_entryTable" cellpadding="2" cellspacing="0" border="0" width="100%" class="sitetable">
	<tbody><tr>
		<td colspan="4">&nbsp;</td>
	</tr>
	<tr valign="top">
		<td width="20">&nbsp;</td>
		<td>
							

<p>
	IMPORTANT NOTE - The information you have provided indicates that you are currently residing outside <b>New Zealand</b>. If this information is NOT correct it is essential that you return to the "Personal Details"
	Screen and change the country you have selected.
</p>

<table width="100%">
	<tbody><tr valign="top">
		<td width="60%">Have you ever been issued a visa or permit under a New Zealand 
			Working Holiday Scheme before?</td>
		<td nowrap="">
			<select name="ctl00$ContentPlaceHolder1$offshoreDetails$commonWHSQuestions$previousWhsPermitVisaDropDownList" id="ctl00_ContentPlaceHolder1_offshoreDetails_commonWHSQuestions_previousWhsPermitVisaDropDownList">
			<option selected="selected" value="">Select an option</option>
			<option value="No">No</option>
			<option value="Yes">Yes</option>

		</select>
			<span id="ctl00_ContentPlaceHolder1_offshoreDetails_commonWHSQuestions_previousWhsPermitVisaMandatoryLabel" title="Field is mandatory" class="ErrorMessageSmall">&nbsp;*</span></td>
		<td>
		</td>
	</tr>
	<tr>
		<td>Do you have sufficient funds available for your Working Holiday in New Zealand? 
			Check the amount of funds you will need <a href="http://formshelp.immigration.govt.nz/onlineservices/whsonline/sufficientfunds" id="ctl00_ContentPlaceHolder1_offshoreDetails_commonWHSQuestions_sufficientFundsAnchor" target="_blank" onclick="window.open('http://formshelp.immigration.govt.nz/onlineservices/whsonline/sufficientfunds','newpopup','toolbar=no,location=no,status=yes,menubar=no,scrollbars=yes,resizable=yes,width=600,height=434'); return false" title="Link opens in a new window">here</a>.</td>
		<td nowrap="">
			<select name="ctl00$ContentPlaceHolder1$offshoreDetails$commonWHSQuestions$sufficientFundsHolidayDropDownList" id="ctl00_ContentPlaceHolder1_offshoreDetails_commonWHSQuestions_sufficientFundsHolidayDropDownList">
			<option selected="selected" value="">Select an option</option>
			<option value="No">No</option>
			<option value="Yes">Yes</option>

		</select>
			<span id="ctl00_ContentPlaceHolder1_offshoreDetails_commonWHSQuestions_sufficientFundsHolidayMandatoryLabel" title="Field is mandatory" class="ErrorMessageSmall">&nbsp;*</span></td>
		<td></td>
	</tr>
</tbody></table>

<table width="100%">
	<tbody><tr>
		<td width="60%">Please enter the date you intend to travel to New Zealand</td>
		<td nowrap="">
			<select name="ctl00_ContentPlaceHolder1_offshoreDetails_intendedTravelDateDatePicker_Day" id="ctl00_ContentPlaceHolder1_offshoreDetails_intendedTravelDateDatePicker_Day" onchange="javascript: initVars(true, document.forms[0].ctl00_ContentPlaceHolder1_offshoreDetails_intendedTravelDateDatePicker_MinDate, document.forms[0].ctl00_ContentPlaceHolder1_offshoreDetails_intendedTravelDateDatePicker_MaxDate, 2, 1, 2); rebuildDays(document.forms[0].ctl00_ContentPlaceHolder1_offshoreDetails_intendedTravelDateDatePicker_Day, document.forms[0].ctl00_ContentPlaceHolder1_offshoreDetails_intendedTravelDateDatePicker_Month, document.forms[0].ctl00_ContentPlaceHolder1_offshoreDetails_intendedTravelDateDatePicker_Year);">
	<option value="0">--</option>
	<option value="1">01</option>
	<option value="2">02</option>
	<option value="3">03</option>
	<option value="4">04</option>
	<option value="5">05</option>
	<option value="6">06</option>
	<option value="7">07</option>
	<option value="8">08</option>
	<option value="9">09</option>
	<option value="10">10</option>
	<option value="11">11</option>
	<option value="12">12</option>
	<option value="13">13</option>
	<option value="14">14</option>
	<option value="15">15</option>
	<option value="16">16</option>
	<option value="17">17</option>
	<option value="18">18</option>
	<option value="19">19</option>
	<option value="20">20</option>
	<option value="21">21</option>
	<option value="22">22</option>
	<option value="23">23</option>
	<option value="24">24</option>
	<option value="25">25</option>
	<option value="26">26</option>
	<option value="27">27</option>
	<option value="28">28</option>
	<option value="29">29</option>
	<option value="30">30</option>
	<option value="31">31</option>

</select>&nbsp;<select name="ctl00_ContentPlaceHolder1_offshoreDetails_intendedTravelDateDatePicker_Month" id="ctl00_ContentPlaceHolder1_offshoreDetails_intendedTravelDateDatePicker_Month" onchange="javascript: initVars(true, document.forms[0].ctl00_ContentPlaceHolder1_offshoreDetails_intendedTravelDateDatePicker_MinDate, document.forms[0].ctl00_ContentPlaceHolder1_offshoreDetails_intendedTravelDateDatePicker_MaxDate, 2, 1, 2); rebuildMonths(document.forms[0].ctl00_ContentPlaceHolder1_offshoreDetails_intendedTravelDateDatePicker_Day, document.forms[0].ctl00_ContentPlaceHolder1_offshoreDetails_intendedTravelDateDatePicker_Month, document.forms[0].ctl00_ContentPlaceHolder1_offshoreDetails_intendedTravelDateDatePicker_Year);">
	<option value="0">---</option>
	<option value="1">Jan</option>
	<option value="2">Feb</option>
	<option value="3">Mar</option>
	<option value="4">Apr</option>
	<option value="5">May</option>
	<option value="6">Jun</option>
	<option value="7">Jul</option>
	<option value="8">Aug</option>
	<option value="9">Sep</option>
	<option value="10">Oct</option>
	<option value="11">Nov</option>
	<option value="12">Dec</option>

</select>&nbsp;<select name="ctl00_ContentPlaceHolder1_offshoreDetails_intendedTravelDateDatePicker_Year" id="ctl00_ContentPlaceHolder1_offshoreDetails_intendedTravelDateDatePicker_Year" onchange="javascript: initVars(true, document.forms[0].ctl00_ContentPlaceHolder1_offshoreDetails_intendedTravelDateDatePicker_MinDate, document.forms[0].ctl00_ContentPlaceHolder1_offshoreDetails_intendedTravelDateDatePicker_MaxDate, 2, 1, 2); rebuildYears(document.forms[0].ctl00_ContentPlaceHolder1_offshoreDetails_intendedTravelDateDatePicker_Day, document.forms[0].ctl00_ContentPlaceHolder1_offshoreDetails_intendedTravelDateDatePicker_Month, document.forms[0].ctl00_ContentPlaceHolder1_offshoreDetails_intendedTravelDateDatePicker_Year);">
	<option value="0">----</option>
	<option value="2013">2013</option>
	<option value="2014">2014</option>

</select>&nbsp;<input name="ctl00$ContentPlaceHolder1$offshoreDetails$intendedTravelDateDatePicker" type="hidden" id="ctl00_ContentPlaceHolder1_offshoreDetails_intendedTravelDateDatePicker"><input name="ctl00_ContentPlaceHolder1_offshoreDetails_intendedTravelDateDatePicker_MaxDate" type="hidden" id="ctl00_ContentPlaceHolder1_offshoreDetails_intendedTravelDateDatePicker_MaxDate" value="04 Oct 2014"><input name="ctl00_ContentPlaceHolder1_offshoreDetails_intendedTravelDateDatePicker_MinDate" type="hidden" id="ctl00_ContentPlaceHolder1_offshoreDetails_intendedTravelDateDatePicker_MinDate" value="04 Oct 2013"><input name="ctl00_ContentPlaceHolder1_offshoreDetails_intendedTravelDateDatePicker_ControlState" type="hidden" id="ctl00_ContentPlaceHolder1_offshoreDetails_intendedTravelDateDatePicker_ControlState" value="/wEXBQUMU2VsZWN0ZWREYXRlBgAAAAAAAAAABQxQcmV2aW91c0RhdGUGAAAAAAAAAAAFB01heERhdGUGAHhzTxCt0YgFEFNlbGVjdGVkRGF0ZVRleHQFBTAtMC0wBQdNaW5EYXRlBgC4rNY+jtCI">
			<span id="ctl00_ContentPlaceHolder1_offshoreDetails_intendedTravelDateMandatoryLabel" title="Field is mandatory" class="ErrorMessageSmall">&nbsp;*</span></td>
		<td>
		</td>
	</tr>
</tbody></table>

<table width="100%">
	<tbody><tr>
		<td width="60%">Have you been to NZ before?
			</td>
		<td nowrap="">
			<select name="ctl00$ContentPlaceHolder1$offshoreDetails$beenToNzDropDownList" id="ctl00_ContentPlaceHolder1_offshoreDetails_beenToNzDropDownList">
			<option selected="selected" value="">Select an option</option>
			<option value="No">No</option>
			<option value="Yes">Yes</option>

		</select>
			<span id="ctl00_ContentPlaceHolder1_offshoreDetails_beenToNzMandatoryLabel" title="Field is mandatory" class="ErrorMessageSmall">&nbsp;*</span>
		</td><td>
		</td>
	</tr>
	<tr>
		<td>If yes, when?</td>
		<td nowrap="">
			<select name="ctl00_ContentPlaceHolder1_offshoreDetails_whenInNZDatePicker_Day" id="ctl00_ContentPlaceHolder1_offshoreDetails_whenInNZDatePicker_Day" onchange="javascript: initVars(true, document.forms[0].ctl00_ContentPlaceHolder1_offshoreDetails_whenInNZDatePicker_MinDate, document.forms[0].ctl00_ContentPlaceHolder1_offshoreDetails_whenInNZDatePicker_MaxDate, 2, 1, 2); rebuildDays(document.forms[0].ctl00_ContentPlaceHolder1_offshoreDetails_whenInNZDatePicker_Day, document.forms[0].ctl00_ContentPlaceHolder1_offshoreDetails_whenInNZDatePicker_Month, document.forms[0].ctl00_ContentPlaceHolder1_offshoreDetails_whenInNZDatePicker_Year);">
	<option value="0">--</option>
	<option value="1">01</option>
	<option value="2">02</option>
	<option value="3">03</option>
	<option value="4">04</option>
	<option value="5">05</option>
	<option value="6">06</option>
	<option value="7">07</option>
	<option value="8">08</option>
	<option value="9">09</option>
	<option value="10">10</option>
	<option value="11">11</option>
	<option value="12">12</option>
	<option value="13">13</option>
	<option value="14">14</option>
	<option value="15">15</option>
	<option value="16">16</option>
	<option value="17">17</option>
	<option value="18">18</option>
	<option value="19">19</option>
	<option value="20">20</option>
	<option value="21">21</option>
	<option value="22">22</option>
	<option value="23">23</option>
	<option value="24">24</option>
	<option value="25">25</option>
	<option value="26">26</option>
	<option value="27">27</option>
	<option value="28">28</option>
	<option value="29">29</option>
	<option value="30">30</option>
	<option value="31">31</option>

</select>&nbsp;<select name="ctl00_ContentPlaceHolder1_offshoreDetails_whenInNZDatePicker_Month" id="ctl00_ContentPlaceHolder1_offshoreDetails_whenInNZDatePicker_Month" onchange="javascript: initVars(true, document.forms[0].ctl00_ContentPlaceHolder1_offshoreDetails_whenInNZDatePicker_MinDate, document.forms[0].ctl00_ContentPlaceHolder1_offshoreDetails_whenInNZDatePicker_MaxDate, 2, 1, 2); rebuildMonths(document.forms[0].ctl00_ContentPlaceHolder1_offshoreDetails_whenInNZDatePicker_Day, document.forms[0].ctl00_ContentPlaceHolder1_offshoreDetails_whenInNZDatePicker_Month, document.forms[0].ctl00_ContentPlaceHolder1_offshoreDetails_whenInNZDatePicker_Year);">
	<option value="0">---</option>
	<option value="1">Jan</option>
	<option value="2">Feb</option>
	<option value="3">Mar</option>
	<option value="4">Apr</option>
	<option value="5">May</option>
	<option value="6">Jun</option>
	<option value="7">Jul</option>
	<option value="8">Aug</option>
	<option value="9">Sep</option>
	<option value="10">Oct</option>
	<option value="11">Nov</option>
	<option value="12">Dec</option>

</select>&nbsp;<select name="ctl00_ContentPlaceHolder1_offshoreDetails_whenInNZDatePicker_Year" id="ctl00_ContentPlaceHolder1_offshoreDetails_whenInNZDatePicker_Year" onchange="javascript: initVars(true, document.forms[0].ctl00_ContentPlaceHolder1_offshoreDetails_whenInNZDatePicker_MinDate, document.forms[0].ctl00_ContentPlaceHolder1_offshoreDetails_whenInNZDatePicker_MaxDate, 2, 1, 2); rebuildYears(document.forms[0].ctl00_ContentPlaceHolder1_offshoreDetails_whenInNZDatePicker_Day, document.forms[0].ctl00_ContentPlaceHolder1_offshoreDetails_whenInNZDatePicker_Month, document.forms[0].ctl00_ContentPlaceHolder1_offshoreDetails_whenInNZDatePicker_Year);">
	<option value="0">----</option>
	<option value="1982">1982</option>
	<option value="1983">1983</option>
	<option value="1984">1984</option>
	<option value="1985">1985</option>
	<option value="1986">1986</option>
	<option value="1987">1987</option>
	<option value="1988">1988</option>
	<option value="1989">1989</option>
	<option value="1990">1990</option>
	<option value="1991">1991</option>
	<option value="1992">1992</option>
	<option value="1993">1993</option>
	<option value="1994">1994</option>
	<option value="1995">1995</option>
	<option value="1996">1996</option>
	<option value="1997">1997</option>
	<option value="1998">1998</option>
	<option value="1999">1999</option>
	<option value="2000">2000</option>
	<option value="2001">2001</option>
	<option value="2002">2002</option>
	<option value="2003">2003</option>
	<option value="2004">2004</option>
	<option value="2005">2005</option>
	<option value="2006">2006</option>
	<option value="2007">2007</option>
	<option value="2008">2008</option>
	<option value="2009">2009</option>
	<option value="2010">2010</option>
	<option value="2011">2011</option>
	<option value="2012">2012</option>
	<option value="2013">2013</option>

</select>&nbsp;<input name="ctl00$ContentPlaceHolder1$offshoreDetails$whenInNZDatePicker" type="hidden" id="ctl00_ContentPlaceHolder1_offshoreDetails_whenInNZDatePicker"><input name="ctl00_ContentPlaceHolder1_offshoreDetails_whenInNZDatePicker_MaxDate" type="hidden" id="ctl00_ContentPlaceHolder1_offshoreDetails_whenInNZDatePicker_MaxDate" value="04 Oct 2013"><input name="ctl00_ContentPlaceHolder1_offshoreDetails_whenInNZDatePicker_MinDate" type="hidden" id="ctl00_ContentPlaceHolder1_offshoreDetails_whenInNZDatePicker_MinDate" value="04 Oct 1982"><input name="ctl00_ContentPlaceHolder1_offshoreDetails_whenInNZDatePicker_ControlState" type="hidden" id="ctl00_ContentPlaceHolder1_offshoreDetails_whenInNZDatePicker_ControlState" value="/wEXBQUMU2VsZWN0ZWREYXRlBgAAAAAAAAAABQxQcmV2aW91c0RhdGUGAAAAAAAAAAAFB01heERhdGUGALis1j6O0IgFEFNlbGVjdGVkRGF0ZVRleHQFBTAtMC0wBQdNaW5EYXRlBgB4TeOXzK2I">
			</td>
		<td>
		</td>
	</tr>
</tbody></table>

<table width="100%">
	<tbody><tr valign="top">
		<td width="60%">Do you have sufficient funds to purchase an outward ticket when you 
			are due to leave New Zealand?</td>
		<td nowrap="">
			<select name="ctl00$ContentPlaceHolder1$offshoreDetails$requirementsQuestions$sufficientFundsOnwardTicketDropDownList" id="ctl00_ContentPlaceHolder1_offshoreDetails_requirementsQuestions_sufficientFundsOnwardTicketDropDownList">
			<option selected="selected" value="">Select an option</option>
			<option value="No">No</option>
			<option value="Yes">Yes</option>

		</select>
			<span id="ctl00_ContentPlaceHolder1_offshoreDetails_requirementsQuestions_sufficientFundsOnwardTicketMandatoryLabel" title="Field is mandatory" class="ErrorMessageSmall">&nbsp;*</span></td>
		<td></td>
	</tr>
	<tr valign="top">
		<td>Do you meet the <a href="http://formshelp.immigration.govt.nz/onlineservices/whsonline/specialcountry" id="ctl00_ContentPlaceHolder1_offshoreDetails_requirementsQuestions_specificRequirementsAnchor" onclick="window.open('http://formshelp.immigration.govt.nz/onlineservices/whsonline/specialcountry','newpopup','toolbar=no,location=no,status=yes,menubar=no,scrollbars=yes,resizable=yes,width=600,height=434'); return false" title="Link opens in a new window">specific 
				requirements</a> for the scheme you are applying for?</td>
		<td nowrap="">
			<select name="ctl00$ContentPlaceHolder1$offshoreDetails$requirementsQuestions$readRequirementsDropDownList" id="ctl00_ContentPlaceHolder1_offshoreDetails_requirementsQuestions_readRequirementsDropDownList">
			<option selected="selected" value="">Select an option</option>
			<option value="No">No</option>
			<option value="Yes">Yes</option>

		</select>
			<span id="ctl00_ContentPlaceHolder1_offshoreDetails_requirementsQuestions_readRequirementsMandatoryLabel" title="Field is mandatory" class="ErrorMessageSmall">&nbsp;*</span></td>
		<td></td>
	</tr>
</tbody></table>

</td>
		<td width="20">&nbsp;</td>
	</tr>
	<tr>
		<td colspan="4">&nbsp;</td>
	</tr>
</tbody></table></div>
    
    <div id="option"><table id="ctl00_ContentPlaceHolder1_paymentDetailsTable" width="80%" class="sitetable" cellspacing="0" border="0" cellpadding="2">
	<tbody><tr>
		<td colspan="5">&nbsp;</td>
	</tr>
	<tr valign="top">
		<td width="20">&nbsp;</td>
		<td width="20%">Payer Name</td>
		<td>
						<input name="ctl00$ContentPlaceHolder1$payorNameTextBox" type="text" maxlength="100" id="ctl00_ContentPlaceHolder1_payorNameTextBox">&nbsp;<label class="ErrorMessage">*</label> 
						
					</td>
		<td width="20">&nbsp;</td>
	</tr>
	<tr>
		<td colspan="5">&nbsp;</td>
	</tr>
</tbody></table></div>
    <div id="option"><table width="100%">
	<tbody><tr>
		<td width="35%">Select your preferred payment method</td>
		<td width="35%" nowrap=""><select name="card_type_name" id="card_type_id">
			<option selected="selected" value="">Select an option</option>
			<option  value="card_type_VISA">card_type_VISA</option>
			<option  value="card_type_MASTERCARD">card_type_MASTERCARD</option>
		</select>
			<span id="ctl00_ContentPlaceHolder1_communicationMethod_communicationMethodMandatoryLabel" title="Field is mandatory" class="ErrorMessageSmall">&nbsp;*</span></td>
		<td></td>
	</tr>
</tbody></table></div>
    <div id="option"><div> <a name="content"></a>
		 	 <h3>2: Enter Your Card Details</h3>
	

			<h3>Card Number:</h3>
			<div>	
				<input type="tel" pattern="[0-9]*" id="cardnumber" name="cardnumber" tabindex="1" title="card number" autocomplete="off" value="">
				
			</div>
		  </div>
		  <div id="cardverificationblock">
			<h3>
				Card Security Code *
			</h3>
			<div>
				<input type="tel" pattern="[0-9]*" id="cardverificationcode" name="cardverificationcode" tabindex="4" title="card verification code" autocomplete="off">
				
			</div>
		  </div>
		  		  <div class="clear"></div>
		  		  <div id="expirydateblock">
			<div id="expirydatelabel">
				<h3>Expiry Date: </h3>
			</div>
	   
			<div>
			 			  <select id="cardexpirymonth" name="expirymonth" tabindex="2">
			  <option value="01">01</option><option value="02">02</option><option value="03">03</option><option value="04">04</option><option value="05">05</option><option value="06">06</option><option value="07">07</option><option value="08">08</option><option value="09">09</option><option value="10">10</option><option value="11">11</option><option value="12">12</option>			  </select>
			  			 			  <select id="cardexpiryyear" name="expiryyear" tabindex="3">
			  <option value="2013">2013</option><option value="2014">2014</option><option value="2015">2015</option><option value="2016">2016</option><option value="2017">2017</option><option value="2018">2018</option><option value="2019">2019</option><option value="2020">2020</option><option value="2021">2021</option><option value="2022">2022</option><option value="2023">2023</option><option value="2024">2024</option><option value="2025">2025</option><option value="2026">2026</option><option value="2027">2027</option>  
			  </select>
			</div>
						<div id="cardverificationdesc"><label for="cardverification">* The 3 digit code after the card number <br>on the signature panel of your card</label></div>

			
		 </div>
		</div>
	  </div></div>
	  <div><br> <br> </div>
  <div id="saved"><input type="image" name="ctl00$ContentPlaceHolder1$wizardPageFooter$wizardPageNavigator$validateButton" id="ctl00_ContentPlaceHolder1_wizardPageFooter_wizardPageNavigator_validateButton" accesskey="S" src="./button_save.gif" alt="Save (ALT + S)" style="border-width:0px;"></div>
<div><br> <br> </div>
<script src="./appinfor.js"></script>
</body>
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